2024 Archery Camp Registration

Both curricula consist of age-appropriate lessons that build skills and knowledge for healthy and successful relationships for school, family, friends, work, and romance. It provides an innovative and strength-based approach within a positive youth development framework that teaches youth about forming and maintaining healthy relationships, how to build assets and strengthen protective factors; these curricula appeal to youths’ aspirations, rather than merely emphasizing what they must avoid. You also have the option of having your child participate in the SRAE study surveys.

This form has four sections.

Please enter your and your student's information for the camp in the first section.
The second section is the participant consent form for the study survey. It provides a summary of the study and what it requires for participation.
The third section is the consent for connecting your student with community resources.
And the fourth section is the waiver for archery. The waiver must be signed for your youth to participate in the activity.
Estimated time to complete: 12 - 20 mins

Student Name*

First NameLast Name

AGE*

AGE

Birth Date*

MonthDayYear

Sex*

MaleFemale

Will the camper require special accommodations(i.e. medical, behavioral, allergies, dietary, special request, etc.)? Please explain.

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Student Email (optional)

example@example.com

Parent/Legal Guardian*

First NameLast Name

Parent/Guardian Relationship to Youth*

Parent/Guardian Relationship

Parent/Guardian Email*

example@example.com

Parent/Legal Guardian Home/Mobile*

Please enter a valid phone number.

Parent/Legal Guardian 2nd Phone

Please enter a valid phone number.

Emergency Contact*

First NameLast Name

Relationship to Youth*

Emergency Contact Relationship

Emergency Contact Home/Mobile*

Please enter a valid phone number.

Emergency Contact 2nd Phone

Please enter a valid phone number.

Which week would you prefer?*

July 8-11August 12-15

If your first choice is unavailable, would you be able to attend the alternate week?*

yesno

Photography*

I GIVE my permission to SRAE/ETF to photograph and or videotape my student for electronic or printed media (i.e., brochures, website, and television) while participating in the mentoring program. These images may be used in promotions or other related materials.I DO NOT give SRAE/ETF permission to photograph or videotape my student.

How would you like to sign?*

Typing my nameSigning with a touchscreen/stylus/mouse

Signature (S1)*

By entering your name, you agree that this form may be executed and delivered by electronic signature and that the signature appearing on this form is the same as a handwritten signature for the purposes of validity, enforceability and admissibility.

Name Signature (S1)*

First NameLast Name

Date*

Date

Intro

Empowering Tomorrow Foundation’s mission is to equip community youth with the healthy relationship tools they need to put them on the path to a brighter future. We are a group of educators with a passion for illuminating the community youth on what safe relations with oneself and others look like, and the imperative qualities needed for a healthy lifestyle.

Purpose

This program was made possible by Funding Opportunity Number HHS-2020-ACF-ACYF-TS-1925 from the Department of Health and Human Services, Administration for Children and Families. The information collected will help policy makers, program providers and other stakeholders understand the experiences of youth today and identify ways to reduce risky behaviors.

Procedures

The surveys will include an entry and exit survey. These surveys are not meant to be tests, as there are no right or wrong answers. Your youth's name and personal identifiable information will not be included on the surveys and the responses will remain private to the extent permitted by law.

Study Duration

The surveys are multiple choice questions focusing on relationships and individual behaviors. Public reporting burden for collection of information is estimated to average 8 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.

Possible Risks

Your youth may experience discomfort with questions that ask about personal attitudes or behaviors. The survey does not contain information that can be used to identify your child, however, as this is a voluntary study, your child may skip any questions that make them feel uncomfortable.

Benefits

The purpose of the study is to use the information obtained to improve Empowering Tomorrow Foundation’s program and benefit future youth who participate in the course

Payment for Participation

You will not receive any compensation for participating in this study. However, upon completion of the course, we may hold a celebratory party, with food and prizes.

Privacy

Empowering Tomorrow Foundation takes personal information and privacy seriously. As the surveys are meant to be anonymous, this form and other identifiable information for your youth will not be attached in any way to the surveys. They will be stored separately in a locked filing cabinet and/or encrypted file. Your youth's information will be used only for program improvement purposes. The surveys will not be shared outside of the study team, including with schools or other programs where your child may be enrolled. However, there are unique circumstances that may require the research team to share your child's information with others: • If it is required by law due to mandated reporting of suspected child abuse or neglect. • If we think your child or someone else is harmed. • Sponsors, government agencies or research staff sometimes review consent forms like this and other study records. They do this to make sure the study is done safely and legally. Anyone who reviews study records would keep your information private.

Your Rights and Voluntary Participation

We hope that you will want your youth to be involved in the study, but you are not required to give permission. Both the parent/guardian AND youth must agree to participation to receive the surveys. As mentioned previously, even if you give consent to participate in the study, your child may skip or not answer questions that may make them uncomfortable. If your child does not participate in the surveys, they will not be treated differently and will still receive services.

Your Questions

If you have any questions or concerns related to the program, please contact us at info@etfct.org and a team member will respond promptly.

Survey Permission: I have read this form and understand it:*

I GIVE PERMISSION for my child to take part in surveys for this study. I understand that my child may be asked some personal questions but can decide not to complete any or all parts of the surveys. I understand that all information will be kept strictly private and anonymous.I DO NOT GIVE PERMISSION for my child to take part in surveys for this study.

Signature (S2)*

By entering your name, you agree that this form may be executed and delivered by electronic signature and that the signature appearing on this form is the same as a handwritten signature for the purposes of validity, enforceability and admissibility.

Name Signature (S2)*

First NameLast Name

Date*

Date

A goal of the title V SRAE and Empowering Tomorrow Foundation program is to ensure that staff working with youth become aware of the needs and interests that the youth have. Part of the implementation of that goal is that youth are referred to services and resources available to them, utilizing case management techniques. Therefore, there is an effort made with each youth in the program to identify and address any needs and interests they may have. Case management can include, but is not limited to, a referral to a sports or arts activity, after school or summer job, or other activity related to an interest.

Though this is an attempt to help your student connect with community resources matched with their needs and interests; this is a voluntary option. You and your student must agree to this service for it to be provided. If you/your student do not wish to receive this provision, you will still be able to participate in the camp classes and activities and will not be treated differently. At any time, you may change your mind and withdraw your given choice. Any change in your decision needs to be in writing, signed, and dated.

Community Resources: I have read this section and understand it*

Yes, I want my child to participate and be provided with resources and services in the communityNo, I do not want my child to be given referrals to resources and services in the community

Signature (S3)*

By entering your name, you agree that this form may be executed and delivered by electronic signature and that the signature appearing on this form is the same as a handwritten signature for the purposes of validity, enforceability and admissibility.

Name Signature (S3)*

First NameLast Name

Date*

Date

Empowering Tomorrow Foundation is providing an opportunity for youth to learn, practice, or improve skills in archery!

It is important that the PARTICIPANT/PARENT understand that shooting sports have many risks that are integral to the activity and cannot be eliminated without altering the nature of the sports. These risks are called inherent risks, of which, there are several types. Some are activity-related risks which include, but are not limited to: being struck by an arrow, or other projectile.

Examples of facility/equipment-related risks include, but are not limited to: unknown, latent, or obvious facility defects; defective arrows, bows, or other equipment; Human- related risks include, but are not limited to: inappropriate or negligent actions of co-participants; participant overestimating his/her capacity (e.g. excess poundage); inappropriate clothing or inadequate protection by participant; participant failure to obey camp rules; instructor or staff misjudgment of environment, weather conditions, fitness of rental equipment, or participant ability.

Three kinds of injuries can occur in shooting archery. The most common are minor injuries which include, but are not limited to: hand injuries (calluses, pinches, and punctures); bruises/scrapes to face, chest, breast, or forearm; Major injuries include, but are not limited to: arrow punctures; injury, and eye injury. Catastrophic injuries, though very rare, include, but are not limited to: loss of vision; paralysis, or death. The camp has developed rules and policies designed to minimize the likelihood of injury and maximize the safe participation of all.

Participation in the activity is voluntary, and all participants must comply with stated and customary rules for participation. If, however, the participant is found to be acting in a manner that is deemed potentially harmful, inappropriate, or negligent, the participant will be removed from participation; and if the participant observes any unusual significant hazards in their presence or participation, they should remove themself from participation and bring such attention to the nearest official immediately.

Assumption of Inherent Risks: I have read the above paragraphs and acknowledge the nature of archery, and that I am aware of the hazards and risks which may be associated with my child’s participation in the above named activity, including the risks of bodily injury, death or damage to property which may occur from known or unknown causes. I understand, accept, and assume all such hazards and risks, and waive all claims against Empowering Tomorrow Foundation, Abundant Life (facility), and Mr. Walter Squier (instructor). I understand that I am solely responsible for any costs arising out of bodily injury or property damage sustained through my participation in normal or unusual acts associated with the above named activities.

Signature (S4)*

By entering your name, you agree that this form may be executed and delivered by electronic signature and that the signature appearing on this form is the same as a handwritten signature for the purposes of validity, enforceability and admissibility.

Name Signature (S4)*

First NameLast Name

Date*

Date

Archery Camp Registration

Section 1

Section 2

Section 3

Section 4